ObjectiveTo investigate the effect of different exercise interventions on metabolism and liver parameters in patients with metabolic dysfunction-associated fatty liver disease （MAFLD）， and to provide evidence-based recommendations for clinical exercise rehabilitation. MethodsThis study was conducted according to the PRISMA guidelines， and the protocol was registered on the PROSPERO platform， with a registration number of CRD42025641717. PubMed， Web of Science， Scopus， Wiley Online Library， CNKI， Wanfang Data， and VIP were searched for related articles published up to September 2024. The Cochrane tool for assessing risk of bias was used to assess the quality of articles， and Stata MP 17.0 was used to perform the network meta-analysis. ResultsA total of 57 articles were included， involving 2 648 patients. The results showed that aerobic exercise combined with resistance exercise had the best effect in improving body mass index （mean difference ［WMD］=-0.97， 95% confidence interval ［CI］： -1.66 to -0.28］， P<0.05， surface under the cumulative ranking curve ［SUCRA］=85.4） and triglycerides （WMD=-29.6， 95%CI： -46.66 to 12.54， P<0.05， SUCRA=87.3）； resistance exercise was the optimal intervention method for improving total cholesterol （WMD=-15.99， 95%CI： -24.19 to -7.79， P<0.05， SUCRA=79.9） and glutamine transaminase （WMD=-8.08， 95%CI： -12.13 to -4.02， P<0.05， SUCRA=87.3）； low-intensity aerobic exercise had the best effect in improving aspartate aminotransferase （WMD=-4.3， 95%CI： -8.45 to -0.15， P<0.05， SUCRA=73.5）， gamma-glutamyl transpeptidase （GGT） （WMD=-3.26， 95%CI： -7.79 to 1.27， P>0.05， SUCRA=82.3）， and glycated hemoglobin （HbA1c） （WMD=-0.6， 95%CI： -2.02 to 0.82， P>0.05， SUCRA=78.8）； moderate-intensity aerobic exercise was the optimal intervention modality to improve Homeostasis Model Assessment of Insulin Resistance （WMD=-0.92， 95%CI： -1.51 to -0.33， P<0.05， SUCRA=69.4）. It should be noted that there were no significant differences in HbA1c and GGT across different exercise interventions （all P>0.05）， suggesting that there was currently no sufficient statistical evidence to support that exercise could improve these two indicators. ConclusionBased on the comprehensive league table and cumulative probability ranking， aerobic exercise combined with resistance exercise， resistance exercise， and low- and moderate-intensity aerobic exercise may be the best exercise modality for improving key indicators in MAFLD patients， and targeted exercise modalities should be selected for intervention against different indicators； however， due to limitations of the original studies， further studies are needed for validation and exploration.

Objective:To evaluate the effects and underlying mechanisms of metabolites derived from the kidney-reinforcing, blood circulation-activating, and collateral dredging decoction on the proliferation of multiple myeloma (MM) KM3 cells.Methods:MM KM3 cells in the logarithmic growth phase were treated with 3%, 6%, 9%, or 12% metabolites of kidney-reinforcing, blood circulation-activating, and collateral dredging decoction. Cell viability was assessed using the CCK-8 assay. Apoptosis and necrosis were evaluated using flow cytometry and TUNEL staining. Mitochondrial and cellular ultrastructural changes were examined using transmission electron microscopy. mRNA and protein expression levels of dynamin-related protein 1 (Drp1), mitochondrial fission protein 1 (Fis1), mitochondrial fission factor (MFF), PTEN-induced kinase 1 (Pink1), and E3 ubiquitin ligase (Parkin) were determined through quantitative real-time PCR and western blotting. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) combined with network pharmacology, was utilized for reverse verification of the pharmacodynamic mechanisms and therapeutic targets underlying the anti-MM activity of this decoction.Results:The metabolites of the kidney-reinforcing, blood circulation-activating, and collateral dredging decoction inhibited KM3 cell proliferation and induced apoptosis in a dose-dependent manner. Transmission electron microscopy revealed increased mitochondrial fission and autophagic structures, with effects intensifying at higher metabolite concentrations. mRNA and protein expression of Drp1, Fis1, MFF, Pink1, and Parkin were significantly upregulated in treatment groups compared to controls ( P<0.05), with the most pronounced effects observed in the 12% metabolite group ( P<0.01). HPLC-MS/MS identified 121 bioactive compounds in BHTF, which shared 474 overlapping targets with MM. Enrichment analysis suggested that BHTF exerts antitumor effects primarily through apigenin, palmatine, and other key components by modulating TNF, NF-κB, and mitophagy pathways. Conclusion:The kidney-reinforcing and blood circulation-activating and collateral dredging decoction suppresses the proliferation of MM KM3 cells, potentially through mechanisms involving the regulation of mitochondrial dynamics and induction of autophagy.

OBJECTIVE To observe the clinical efficacy of Yijinjing in the treatment of elderly sarcopenia and its effect on chro-nic inflammatory response in patients,and to explore the Yijinjing exercise prescription suitable for elderly patients with sarcopenia.METHODS A total of 120 elderly patients with sarcopenia admitted to the Department of Rehabilitation Medicine,Suzhou Hospital of Traditional Chinese Medicine from September 2022 to September 2024 were selected and randomly divided into a control group and a Yijinjing group,with 60 cases in each group.The control group received health education and dietary guidance,and the Yijinjing group received Yijinjing exercises on the basis of the intervention of the control group.The changes in skeletal muscle mass,upper and lower limb muscle strength,muscle thickness,muscle cross-sectional area,physical fitness and chronic inflammation level were observed in the two groups before and after the intervention.RESULTS After intervention,the skeletal muscle mass,grip strength,30 s sit-stand test times,rectus femoris thickness and cross-sectional area,vastus intermedius thickness,and physical fit-ness assessment of the patients in the Yijinjing group were significantly increased compared with those before treatment(P<0.05),and the indicators after intervention were higher than those in the control group(P<0.05);the serum TNF-α and IL-18 levels in the Yi-jinjing group were significantly decreased compared with those before treatment(P<0.05),and the indicators after intervention were lower than those in the control group(P<0.05);there was no statistically significant change in the biceps brachii thickness and serum IL-6 level in the Yijinjing group compared with those before treatment(P>0.05);there was no significant correlation between the bi-ceps brachii thickness and grip strength after Yijinjing intervention,r=0.139 8,P>0.05;there was a significant negative correlation between the TNF-α level and grip strength after Yijinjing intervention,r=-0.313 8,P<0.05.CONCLUSION Yijinjing exercises can improve muscle mass and strength in elderly patients with sarcopenia,and improve the physical fitness of patients,which may be related to improving the chronic inflammatory state of the body.

Objective To investigate the relationship between serum orexin-A(OXA)and aspartate amin-otransferase(AST)levels and the disease severity and prognosis in patients with acute ischemic stroke(AIS).Methods A total of 167 AIS patients(AIS group)treated at Hebei Provincial People's Hospital from January 2021 to January 2024 and 84 healthy individuals undergoing physical examinations(control group)were selected as the research objects.AIS patients were categorized by severity into mild AIS group[National Institutes of Health Stroke Scale(NIHSS)score＜5,42 cases],moderate AIS group(NIHSS score 5—＜16,56 cases),moderate-to-severe AIS group(NIHSS score 16—＜21,36 cases),and severe AIS group(NIHSS score ≥21,33 cases).Based on 3-month prognosis(modified Rankin scale),patients were divided into poor prognosis group(＞2 grade,54 cases)and good prognosis group(≤2 grade,113 cases).Spearman correlation analysis was used to assess the relationship between NIHSS scores and serum OXA and AST levels in AIS pa-tients.Multivariate unconditional Logistic regression was used to determine the relationship between serum OXA and AST levels and the prognosis of AIS patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of serum OXA and AST levels for prognosis.Results Compared with the control group,serum OXA level in the AIS group was lower,while AST level was higher(P＜0.05).Ser-um OXA level progressively decreased,and AST level progressively increased across the mild,moderate,mod-erately severe,and severe AIS groups(P＜0.05).NIHSS score was negatively correlated with serum OXA level and positively correlated with AST level in AIS patients(P＜0.05).High OXA level was an independent protective factor for poor prognosis in AIS patients,while high AST level was an independent risk factor(P＜0.05).The area under the curve(AUC)of the combined assessment of serum OXA and AST levels in predic-ting poor prognosis in AIS patients was 0.873,which was greater than the AUC of OXA(0.793)and AST(0.770)alone(P＜0.05).Conclusion In AIS patients,lower serum OXA level and higher AST level are as-sociated with disease severity and poor prognosis.The combined evaluation of serum OXA and AST levels has higher predictive value for AIS prognosis.

Objective To investigate the correlations of serum levels of platelet activation com-plex-1(PAC-1)and soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)with neu-rological deficit and clinical prognosis in patients with acute cerebral infarction(ACI).Methods A total of 170 ACI patients(ACI group)and 85 healthy volunteers(control group)were enrolled in this study.Based on severity of neurological deficit assessed by the National Institutes of Health Stroke Scale(NIHSS)score,ACI patients were divided into of mild neurological deficit group(43 cases),moderate neurological deficit group(57 cases),moderate-to-severe neurological deficit group(37 cases),and severe neurological deficit group(33 cases).Additionally,based on the 6-month fol-low-up prognosis,ACI patients were divided into 51 cases of poor prognosis group and 119 cases of good prognosis group.Enzyme-linked immunosorbent assay was used to measure serum levels of PAC-1 and sTWEAK.Spearman correlation analysis was performed to evaluate their correlations with NIHSS scores in ACI patients.Multivariate unconditional Logistic regression analysis was conducted to determine their relationships with clinical prognosis.Receiver operating characteristic curves were used to explore their evaluation efficacy for poor clinical prognosis.Results Serum levels of PAC-1 and sTWEAK were significantly higher in the ACI group than in the control group(P＜0.05).Ser-um levels of PAC-1 and sTWEAK increased sequentially in the mild,moderate,moderate-to-severe,and severe neurological deficit groups(P＜0.05).Spearman correlation analysis showed that serum levels of PAC-1 and sTWEAK were positively correlated with NIHSS scores in ACI patients(rs=0.715 and 0.706,respectively;P＜0.001).Multivariate unconditional Logistic regression analysis revealed that older age,higher NIHSS score,larger infarct volume,higher PAC-1 level,and higher sTWEAK level were independent risk factors for poor prognosis in ACI patients(P＜0.05).The ar-ea under the curve for the combined assessment of serum PAC-1 and sTWEAK levels for poor clini-cal prognosis in ACI patients was 0.895,which was greater than the areas under the curve for the individual assessments(0.792 and 0.786,respectively;P＜0.05).Conclusion Elevated serum levels of PAC-1 and sTWEAK are closely related to increased neurological deficit and poor clinical prognosis in ACI patients.The combined detection of these two markers has high evaluation efficacy for clinical prognosis in ACI patients.

Objective:To investigate the association between frailty and prognosis of elderly patients in the emergency department, and to validate frailty screening tools suitable for the emergency department.Methods:This was a prospective cohort study. Clinical data of elderly patients over 60 years old treated in the emergency department of Beijing Bo'Ai Hospital from January to December 2021 were collected. The Frailty Screening Questionnaire (FSQ), FRAIL Scale (FRAIL) and Clinical Frailty Scale (CFS) were used to score patients, and patients were divided into frail or non-frail group according to the criteria of the above three scales. Twelve-month all-cause mortality was the primary endpoint, dependence and re-admission to the emergency department within 12 months were secondary outcomes. Receiver operating characteristic curves were used to evaluate the ability of the FSQ, FRAIL and CFS scores to predict the primary and secondary endpoints, and the areas under the curve (AUC) were calculated and compared. Survival analysis was performed using Cox hazard proportional regression model, and relative risk was expressed as hazard ratio ( HR) and 95% CI. Results:A total of 406 patients were included in the study. The AUCs (95% CI) of FSQ, FRAIL and CFS scores for predicting 12-month all-cause mortality were 0.879 (0.844-0.909), 0.838 (0.798-0.872), 0.906 (0.873-0.933), respectively (all P<0.001). The AUCs of 3 scores for predicting secondary endpoints ranged from 0.820 to 0.889 (all P<0.001). Pairwise comparisons of the AUCs showed that the CFS was superior to one or both of the other frailty screening scales in predicting 12-month all-cause mortality and dependence except for re-admission to emergency room within 12 months after discharge (all P<0.05). Cox regression analysis revealed that, after adjusting for sex, age, body mass index and comorbidities, frailty as defined by the FSQ, FRAIL, and CFS scales was independently associated with 12-month all-cause mortality, with the HRadj of 3.267 (95% CI: 2.406-4.435), 2.465 (95% CI: 1.819-3.341), 3.523 (95% CI: 2.648-4.687), respectively (all P<0.001). Conclusions:FSQ, FRAIL and CFS scores can predict adverse outcomes, the CFS is a practical frailty screening tool in the emergency department, and frailty screening can improve the risk stratification of older patients.

Objective To explore the significance of detecting serum semaphorin 4D(Sema4D),soluble growth-stimulation expression gene 2 protein(sST2),and Omentin-1 in patients with hypertrophic cardiomyopathy(HCM)accompanied by atrial fibrillation(AF),and to provide reference for clinical diagnosis and treatment.Methods A total of 90 patients with HCM and atrial fibrillation admitted to Tsinghua University Yuquan Hospital(Tsinghua University Integrated Traditional Chinese and Western Medicine Hospital)from January 2022 to December 2023 were selected as the HCM-AF group,and another 90 patients with sinus rhythm HCM in the same stage were selected as the sinus rhythm HCM group.The serum levels of Sema4D,sST2,Omentin-1 and cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)]were compared between the two groups.The correlation between serum Sema4D,sST2,Omentin-1 and cardiac function indicators,as well as the severity of atrial fibrillation in HCM was analyzed.The predictive value of three indicators for atrial fibrillation in HCM was analyzedand the predictive efficacy of percutaneous radiofrequency ablation(PRFA)for the recurrence of atrial fibrillation in HCM patients.Results The serum levels of Sema4D and sST2 in the HCM-AF group were higher than those in the sinus rhythm HCM group,while the levels of Omentin-1 and LVEF were lower than those in the sinus rhythm HCM group,with statistically significant differences(t=2.517～12.325,all P<0.05).The serum levels of Sema4D and sST2 in the persistent subgroup were higher than those in the paroxysmal subgroup,while the levels of Omentin-1 and LVEF were lower than those in the paroxysmal subgroup,the differences were statistically significant(t=2.635～15.931,all P<0.05).Spearman/Pearson correlation analysis showed that serum Sema4D and sST2 were negatively correlated with LVEF(r=-0.57,-0.609,all P<0.001),while Omentin-1 was positively correlated with LVEF(r=0.593,P<0.001).Serum Sema4D and sST2 were positively correlated with the severity of AF in HCM(r=0.625,0.631,all P<0.001),while Omentin-1 was negatively correlated with the severity of AF in HCM(r=-0.617,P<0.001).The serum levels of Sema4D and sST2 in the recurrence subgroup were higher than those in the non-recurrence subgroup,while the serum level of Omentin-1 was lower(t=12.805,7.049,13.345,all P<0.05).The receiver operator characteristic(ROC)curve results showed that the AUC(95%CI)of serum Sema4D,sST2 and Omentin-1 combined to predict atrial fibrillation in HCM was 0.916(0.865～0.952),higher than the individual predictions of the three(Z=3.621,3.657,0.318,all P<0.05).The AUC(95%CI)of serum Sema4D,sST2 and Omentin-1 combined to predict the recurrence of atrial fibrillation in patients with HCM after radiofrequency ablation was 0.931(0.857～0.973),higher than the individual predictions of the three(Z=4.115,3.657,3.853,all P<0.05).Conclusion The levels of serum Sema4D and sST2 in the serum of patients with HCM complicated with atrial fibrillation were elevated,while the level of Omentin-1 was drcreased.Detecting serum Sema4D,sST2 and Omentin-1 has high performance in predicting the occurrence of atrial fibrillation in patients with HCM and the recurrence of atrial fibrillation after radiofrequency ablation therapy.

The floating thrombus in the brachiocephalic artery is relatively rare and difficult to diagnose,and it is prone to be missed.This article reports a case of a patient with a floating thrombus in the brachiocephalic artery who underwent endovascular treatment via a combined radial artery and femoral artery approach.The patient presented with slurred speech,weakness in the left limbs,and dizziness.A cranial DWI examination revealed acute cerebral infarction in the right cerebral hemisphere and bilateral cerebellum.A neck CTA examination showed a floating thrombus in the brachiocephalic artery.Currently,there is no consensus on the treatment of floating thrombi in the brachiocephalic artery.The effect of conservative medical treatment for this patient was poor,and endovascular treatment was administered.The vertebral artery and carotid artery protection umbrellas were deployed via the radial artery approach to prevent intraoperative embolism events.A stent was deployed via the femoral artery approach to adhere to the thrombus.A follow-up neck CTA examination of the patient after the operation indicated that the stent was in a good position with complete thrombus apposition.

Objective To explore the significance of detecting serum semaphorin 4D(Sema4D),soluble growth-stimulation expression gene 2 protein(sST2),and Omentin-1 in patients with hypertrophic cardiomyopathy(HCM)accompanied by atrial fibrillation(AF),and to provide reference for clinical diagnosis and treatment.Methods A total of 90 patients with HCM and atrial fibrillation admitted to Tsinghua University Yuquan Hospital(Tsinghua University Integrated Traditional Chinese and Western Medicine Hospital)from January 2022 to December 2023 were selected as the HCM-AF group,and another 90 patients with sinus rhythm HCM in the same stage were selected as the sinus rhythm HCM group.The serum levels of Sema4D,sST2,Omentin-1 and cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)]were compared between the two groups.The correlation between serum Sema4D,sST2,Omentin-1 and cardiac function indicators,as well as the severity of atrial fibrillation in HCM was analyzed.The predictive value of three indicators for atrial fibrillation in HCM was analyzedand the predictive efficacy of percutaneous radiofrequency ablation(PRFA)for the recurrence of atrial fibrillation in HCM patients.Results The serum levels of Sema4D and sST2 in the HCM-AF group were higher than those in the sinus rhythm HCM group,while the levels of Omentin-1 and LVEF were lower than those in the sinus rhythm HCM group,with statistically significant differences(t=2.517～12.325,all P<0.05).The serum levels of Sema4D and sST2 in the persistent subgroup were higher than those in the paroxysmal subgroup,while the levels of Omentin-1 and LVEF were lower than those in the paroxysmal subgroup,the differences were statistically significant(t=2.635～15.931,all P<0.05).Spearman/Pearson correlation analysis showed that serum Sema4D and sST2 were negatively correlated with LVEF(r=-0.57,-0.609,all P<0.001),while Omentin-1 was positively correlated with LVEF(r=0.593,P<0.001).Serum Sema4D and sST2 were positively correlated with the severity of AF in HCM(r=0.625,0.631,all P<0.001),while Omentin-1 was negatively correlated with the severity of AF in HCM(r=-0.617,P<0.001).The serum levels of Sema4D and sST2 in the recurrence subgroup were higher than those in the non-recurrence subgroup,while the serum level of Omentin-1 was lower(t=12.805,7.049,13.345,all P<0.05).The receiver operator characteristic(ROC)curve results showed that the AUC(95%CI)of serum Sema4D,sST2 and Omentin-1 combined to predict atrial fibrillation in HCM was 0.916(0.865～0.952),higher than the individual predictions of the three(Z=3.621,3.657,0.318,all P<0.05).The AUC(95%CI)of serum Sema4D,sST2 and Omentin-1 combined to predict the recurrence of atrial fibrillation in patients with HCM after radiofrequency ablation was 0.931(0.857～0.973),higher than the individual predictions of the three(Z=4.115,3.657,3.853,all P<0.05).Conclusion The levels of serum Sema4D and sST2 in the serum of patients with HCM complicated with atrial fibrillation were elevated,while the level of Omentin-1 was drcreased.Detecting serum Sema4D,sST2 and Omentin-1 has high performance in predicting the occurrence of atrial fibrillation in patients with HCM and the recurrence of atrial fibrillation after radiofrequency ablation therapy.

OBJECTIVE To observe the clinical efficacy of Yijinjing in the treatment of elderly sarcopenia and its effect on chro-nic inflammatory response in patients,and to explore the Yijinjing exercise prescription suitable for elderly patients with sarcopenia.METHODS A total of 120 elderly patients with sarcopenia admitted to the Department of Rehabilitation Medicine,Suzhou Hospital of Traditional Chinese Medicine from September 2022 to September 2024 were selected and randomly divided into a control group and a Yijinjing group,with 60 cases in each group.The control group received health education and dietary guidance,and the Yijinjing group received Yijinjing exercises on the basis of the intervention of the control group.The changes in skeletal muscle mass,upper and lower limb muscle strength,muscle thickness,muscle cross-sectional area,physical fitness and chronic inflammation level were observed in the two groups before and after the intervention.RESULTS After intervention,the skeletal muscle mass,grip strength,30 s sit-stand test times,rectus femoris thickness and cross-sectional area,vastus intermedius thickness,and physical fit-ness assessment of the patients in the Yijinjing group were significantly increased compared with those before treatment(P<0.05),and the indicators after intervention were higher than those in the control group(P<0.05);the serum TNF-α and IL-18 levels in the Yi-jinjing group were significantly decreased compared with those before treatment(P<0.05),and the indicators after intervention were lower than those in the control group(P<0.05);there was no statistically significant change in the biceps brachii thickness and serum IL-6 level in the Yijinjing group compared with those before treatment(P>0.05);there was no significant correlation between the bi-ceps brachii thickness and grip strength after Yijinjing intervention,r=0.139 8,P>0.05;there was a significant negative correlation between the TNF-α level and grip strength after Yijinjing intervention,r=-0.313 8,P<0.05.CONCLUSION Yijinjing exercises can improve muscle mass and strength in elderly patients with sarcopenia,and improve the physical fitness of patients,which may be related to improving the chronic inflammatory state of the body.